Panminerva Medica 2001 Marzo;43(1):49-52

From the Institute of Internal Medicine and Geriatrics University of Catania, Catania, Italy

Focal seg­mental glo­mer­u­los­cler­osis (­FSGS) is a ­renal dis­ease char­ac­ter­ized by scle­rotic seg­men­tary ­lesions, ­involving a few glom­e­ruli. Male-­female ­ratio is >1 and, in the ­majority of ­cases, the ­patients are ­aged ­between 25 to 35 ­years. The clin­ical pic­ture is sim­ilar to a neph­rotic syn­drome ­with non-selec­tive pro­tei­nuria ­poorly sen­si­tive to ster­oids and ­often asso­ciated ­with micro­hem­a­turia. The eti­ology is ­still ­unknown, ­even if a prev­a­lence in ­drug addic­tors, ­patients ­with ­AIDS and sub­jects ­with recur­rent uro­log­ical infec­tions ­with ­vesico-uret­eral ­reflux was ­observed. Recent ­reports ­showed ­that ­chronic infec­tion Hepatitis C Virus (HCV)-­related may be asso­ciate ­with or respon­sible for ­onset of ­some syn­drome ­involving the ­kidney but not the ­liver. We ­report the ­case of a ­young ­woman ­with HCV-Ab pos­i­tive ­chronic hep­a­titis ­that, ­during the dis­ease, ­showed clin­ical find­ings of ­renal involve­ment, his­to­log­i­cally ­related to a ­FSGS. We admin­is­tered to her ­alpha-IFN at ­doses of 3 Mega Units ­thrice-a-­week for six ­months. Serum HCV-RNA, pro­tei­nuria and hem­a­turia dis­ap­peared simul­ta­ne­ously ­after the treat­ment. We under­line ­that the ­lack of ­finding of HCV anti­gens or HCV-RNA in glo­mer­ular ­lesions (as ­occurred in our ­patient) ­does not ­rule out the ­virus ­role in path­o­gen­esis of immu­no­log­ical neph­ritis. The ­recovery of our ­patient as ­well as the dis­ap­pear­ance of pro­tei­nuria and hem­a­turia ­during IFNalpha treat­ment may be fur­ther evi­dence ­that ­FSGS and ­chronic hep­a­titis HCV-­related are not asso­ciated by ­chance. Further obser­va­tions and per­fec­tioning of diag­nostic tech­niques are ­required to ­clarify the pathog­e­netic rela­tion­ship ­between HCV and ­renal immu­no­log­ical syn­dromes.